Provider Demographics
NPI:1639534563
Name:BREY, BRANDY (CPM, LM)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:BREY
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24931 69TH PL
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-9757
Mailing Address - Country:US
Mailing Address - Phone:262-496-6970
Mailing Address - Fax:
Practice Address - Street 1:24931 69TH PL
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-9757
Practice Address - Country:US
Practice Address - Phone:262-496-6970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI85-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife